Information Collection

Repatriation/Emergency Medical and Dietary Assistance Loan Application

IC 15037 under ICR 201706-1405-005 · OMB 1405-0150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0150 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application	Form and Instruction
DS-3072 Repatriation/Emergency Medical and Dietary Assistance Lo DS-3072 (Fillable) .pdf	Form and Instruction

IC Title:

Repatriation/Emergency Medical and Dietary Assistance Loan Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 71

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-3072	Repatriation/Emergency Medical and Dietary Assistance Loan Application	DS-3072 (Fillable) .pdf		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,459

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,459	13	1,446
Annual IC Time Burden (Hours)	486	4	482
Annual IC Cost Burden (Dollars)	38,830	574	38,256

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.